Biochemical screening in the assessment of erectile dysfunction: what tests decide future therapy?

To evaluate which biochemical tests, performed as screening tests in the assessment of erectile dysfunction (ED), lead to a change in standard treatment. We examined the results of the biochemical and endocrine tests performed as part of the assessment of 1455 men presenting with ED. We also documented the subsequent therapy. We found abnormal findings in testosterone (5.7%), prolactin (0.5%), thyroid function tests (0.13%), liver function tests (12.8%), glucose (9.3%), cholesterol (15% in a subset of 531 men), and ferritin (1.6%). Hyperprolactinemia was not invariably associated with a suppressed testosterone level. Specific therapy with a dopamine agonist for hyperprolactinemia and with testosterone for hypogonadism was effective in treating ED. For the others, standard ED therapy was used. The results of our study showed that screening tests fall into two categories. Testosterone and prolactin have a low yield but specific therapy is effective. Glucose and lipids have a higher yield but specific therapy is not immediately effective for ED. However, they, on their own merits, require management to prevent long-term morbidity and mortality.